Effectiveness and Safety Profile of Oral Tofacitinib in Alopecia Areata: An Observational Study from a Tertiary Hospital.

Introduction: Alopecia areata (AA) is a chronic folliculocentric inflammatory disease with hair loss ranging from patchy to diffuse involvement, with a chronic remitting and relapsing course. It has a multifactorial pathogenesis and immense psychosocial implications. Janus kinase/signal transducers and activators of transcription (JAK-STAT) pathway involving the inhibition of interferon-gamma (IFNγ) and subsequent inflammatory cytokine cascade is its key mechanism of action. Aim: To determine the effectiveness and safety profile of oral tofacitinib in alopecia areata. Materials and Methods: A total of 30 patients with extensive AA, not responding to conventional therapies, were included in this study. Clinical assessment was performed by Severity of Alopecia Tool (SALT) score and dermoscopic assessment by alopecia areata predictive score (AAPS). Results: SALT score at 6 months showed a mean SALT reduction of 79.27% (43.33% of patients), followed by 93.16% (26.67%), 28.24% (20%), and 3.76% (10%). Similarly, at 6 months, we observed a positive change in AAPS of 4.25 (>90% SALT reduction) followed by 2.9 (50%-90%), 1.66 (10%-50%), and 1 (<10%). Highly statistically significant results were achieved. Autoimmune thyroid disease was the most common comorbidity. Mild side effects were observed and managed with dose reduction. Limitations: These included small sample size, less follow-up periods, lack of controls, and non-responders. Conclusion: Oral tofacitinib showed promising results, with most patients showing a >50% (mean = 79.27%) SALT reduction and a mean 2.9 dermoscopic positive change in AAPS assessment. Mild or no side effects were observed.